Anti-Obamacare Ads: A $440 Million Mistake

Remember this anti-Obamacare advertisement?

It didn’t work.

Two recently released studies indicate that advertisements funded by right-leaning political organizations did not have their intended effect. Before the implementation of key coverage provisions of the Affordable Care Act, assessments of the complex reform’s ability to improve healthcare quality, its potential to limit personal freedom through mandated insurance coverage, and its impact on the federal government’s finances were largely conflicting.

It therefore became much easier for the reform’s critics to both politicize and attack it. But as the impact of the Affordable Care Act grows more apparent, arguments that once had the the ability to influence public opinion are not as potent — if they ever were.

Take for example the ad featuring “creepy Uncle Sam.” That minute-long video — which came with the tag “don’t let government play doctor” and asked viewers to “opt out” of Obamacare — was meant to prey on the fear that the reform would allow the government to intervene in the personal lives of Americans to an unbearable extent. While it received millions of views on YouTube, it has become apparent that such an exaggerated claim did not ring true to millions of enrollees.

Now, it seems puzzling that a character wearing an Uncle Sam mask and acting as a perverted gynecologist was chosen to be the face of the $750,000 anti-Obamacare campaign run by Generation Opportunity, an organization with a conservative, anti-Big Government slant backed by billionaire brothers Charles and David Koch.

That ad may be an extreme example of the negative publicity directed at Obamacare, but it does accurately show how the reform’s critics misread the degree to which the insurance exchanges would appeal to uninsured or underinsured Americans. It also represents the extreme nature of the debate over the Affordable Care Act.

The two studies, released this week, suggest that the uninsured population declined considerably as a result of the coverage provisions of the healthcare reform law, that a sizable percentage of the newly insured are happy with the coverage, and that highly politicized campaigns launched against Obamacare played an insignificant role for Americans deciding whether to enroll.

Commonwealth Fund study found that “significantly fewer working-age adults are uninsured than just before the sign-up period began, and many have used their new coverage to obtain needed care.” The adult uninsured rate dropped from 20 percent in the third quarter of 2013 to 15 percent in the second quarter of 2014.

Polling conducted by Gallup has shown a similar decline in the number of uninsured. Approximately 13 percent of the U.S. adult population remains uninsured, even after the implementation of Obamacare’s individual insurance mandate in January. But the survey confirmed that the country’s number of uninsured is declining as a result of the healthcare reform. Data show that across the entire United States, the share of Americans without health insurance has steadily dropped since reaching a peak of 18 percent in the third quarter of 2013; it now stands at low of 13.4 percent.

The Commonwealth Fund survey sought to contextualize enrollment numbers by asking the 4,425 adults it polled between early April and early June how they use their insurance coverage and how they like it. Four of five people with coverage purchased through the new marketplaces or with new Medicaid coverage said they were confident their insurance would improve their ability to access needed healthcare.

Six in 10 said they had already visited a doctor or hospital, or filled a prescription, and of that group, 62 percent said they could not have accessed or afforded this care before the implementation of the key coverage provisions: the exchanges and the expanded Medicaid program. Overall, 73 percent of people who purchased exchange insurance and 87 percent of those who signed up for Medicaid said they were somewhat or very satisfied with the coverage. Even 74 percent of Republican enrollees said they like their insurance.

But this data do contrast with other findings. There is evidence that the law remains deeply unpopular. Interviews conducted by Gallup between May 21 and May 25 revealed that “as of yet, there is no sign that Americans think the new healthcare law is having a net positive effect on their healthcare situations.” The majority of Americans reported that the Affordable Care Act has done little to change their “personal situations” since the research firm first started asking the question in 2012. Still, since the reform’s cornerstone provision — the online insurance marketplaces — launched in October, public sentiment has gradually grown stronger.

The number of respondents who say the law has had a positive effect, 14 percent, is within 1 percentage point of a record high. Yet public opinion has turned increasingly negative, as well. Those Americans polled who say the law has had a harmful effect, 24 percent, is also within 1 point of being the highest negative measure recorded. And predictably, public opinion is guided by political affiliation and insurance status.

In a separate study, the Brookings Institution detailed how anti-Obamacare advertisements “backfired.” Data compiled by nonpartisan research firm Kantar Media CMAG found that the Obamacare opposition has spent $450 million on attack ads so far, outpacing positive advertisements by a ratio of more than 15 to 1.

Based on that information and enrollment data from the Department of Health and Human Services, the Brookings Institution’s Niam Yaraghi calculated how attack advertisements influenced exchange signups on a state-by-state basis. This is what he found:


Source: Niam Yaraghi/Brookings Institution

The blue dots represent states where Senate Democrats are up for re-election, while the red dots represent states where Republican senators are up for re-election; the green dots represent states with no Senate midterms in November.

The four states in which Obamacare opponents spent the most per capita on negative ads are Kentucky, Arkansas, Louisiana, and North Carolina. In each of those four states, midterm congressional elections are expected to be extremely tight.

After adjusting his calculations to account for specific state characteristics — like low per capita income populations and average insurance premiums — Yaraghi noticed a “positive association” between spending by Obamacare opposition and Affordable Care Act enrollments. He theorized that the correlation implied that the attack ads may have unintentionally spread awareness about the government-subsidized insurance provision and the reform’s other benefits.

It’s also true that the prevalence of attack ads also made the public more likely to believe the reform could be repealed. “In the states where more anti-ACA ads are aired, residents were on average more likely to believe that Congress will repeal the ACA in the near future,” Yaraghi wrote. “People who believe that subsidized health insurance may soon disappear could have a greater willingness to take advantage of this one time opportunity.”

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